ടൊയോട്ട ഉടൻ തന്നെ ഏറ്റവും പുതുതലമുറ ഹാരിയർ എസ്‌യുവിയെ കൂടുതൽ അന്താരാഷ്ട്ര വിപണികളിൽ അവതരിപ്പിക്കും. ആദ്യം എസ്‌യുവിയുടെ ലെഫ്റ്റ് ഹാൻഡ് ഡ്രൈവ് പതിപ്പ് ചൈനയിലായിരിക്കും കമ്പനി വിൽപ്പനയ്‌ക്കെത്തിക്കുക.

വാഹന വിപണിയിലെ നിലവിലെ വെല്ലുവിളികള്‍ക്ക് ഇടയിലും പെര്‍ഫോമെന്‍സ് മോഡലായ ഹുറാക്കന്‍ ഇവോ സ്‌പൈഡര്‍ റിയര്‍ വീല്‍ ഡ്രൈവ് (RWD) പതിപ്പിനെ ലംബോര്‍ഗിനിയുടെ കഴിഞ്ഞ ദിവസം അവതരിപ്പിച്ചു.

ടൊയോട്ടയും സുസുക്കിയും ചേർന്ന് ഇന്ത്യൻ-ആഗോള വിപണികൾക്കായി പുതിയ കാറുകളും പ്ലാറ്റ്ഫോമുകളും സാങ്കേതികവിദ്യകളും സംയുക്തമായി വികസിപ്പിച്ചു കൊണ്ടിരിക്കുകയാണ്.

തെരഞ്ഞെടുത്ത മോഡലുകള്‍ക്ക് ഓഫറുകളും ആനുകൂല്യങ്ങളും പ്രഖ്യാപിച്ച് ഹ്യുണ്ടായി. വാറണ്ടി നീട്ടി നല്‍കുക, റോഡ്-സൈഡ് അസിസ്റ്റന്‍സ് തുടങ്ങിയവയും ഇതില്‍ ഉള്‍പ്പെടുത്തിയിട്ടുണ്ടെന്ന് കമ്പനി അറിയിച്ചു.

മാരുതി സിയാസ് (സുസുക്കി സിയാസ്) ഇന്ത്യയിൽ വൻ വിജയം കൈവരിച്ച വാഹനമാണ്, എന്നാൽ മറുവശത്ത് നമ്മുടെ അയൽരാജ്യമായ പാകിസ്ഥാനിൽ മോഡൽ ഒരു വൻ പരാജയമാണ്.

കൊറോണ വൈറസ് വ്യാപനത്തെ തുടർന്ന് രാജ്യത്ത് പ്രഖ്യാപിച്ച ലോക്ക്ഡൗൺ മൂലം ഇന്ത്യൻ വാഹന വ്യവസായം മുമ്പെങ്ങുമില്ലാത്തവിധം കഠിനമായ കാലഘട്ടത്തിലൂടെയാണ് 45 ദിവസത്തോളം കടന്നുപോയത്. ഇപ്പോൾ ലോക്ക്ഡൗൺ ഭാഗികമായി പിൻവലിച്ചതോടെ കമ്പനികൾ തങ്ങളുടെ പ്രവർത്തനം കഴിഞ്ഞ ദിവസം ആരംഭിച്ചു.

2020 മെയ് 8 മുതൽ ചെന്നൈയിലെ ശ്രീപെരുമ്പുദൂർ പ്ലാന്റിൽ ഉത്പാദനം ആരംഭിക്കുമ്പോൾ ഹ്യുണ്ടായി മോട്ടോർസ് ഇന്ത്യ സാമൂഹിക അകലവും സുരക്ഷാ മാനദണ്ഡങ്ങൾ കർശനമായി പാലിക്കുന്നു.

This cohort study compares the characteristics and management of acute heart failure in global regions comprising 44 countries.

This prespecified secondary analysis of the MOMENTUM 3 randomized clinical trial aims to determine whether clinical outcomes of patients with 2 different left ventricular assist devices differed based on preoperative categories of bridge to transplant/bridge to candidacy vs destination therapy.

This study develops and validates a quantitative method to predict the pulmonary to systemic flow ratio in patients with congenital heart disease from chest radiographs using deep learning.

This cohort study assesses whether long-term variability and rate of change of blood pressure from young adulthood to midlife are associated with cardiovascular disease and all-cause mortality by middle age.

Increased attention has focused on shared decision-making (SDM) and use of decision aids for treatment decisions in cardiology. In this issue of JAMA Cardiology, Coylewright et al report the results of a rigorously performed pilot study on the use of a decision aid to facilitate SDM for patients with symptomatic severe aortic stenosis (AS) at high or prohibitive risk for surgery considered for transcatheter aortic valve replacement vs medical therapy. Comparisons were made between encounters before clinicians were trained to use a decision aid and the first and fifth encounters after a decision aid was used. The patient-clinician interactions were audio recorded and later coded by independent reviewers using a validated measure to assess SDM. This mixed-methods study found that SDM significantly improved in a stepwise manner from the initial usual care encounter (before use of a decision aid) to the first and then fifth encounters after implementation of the decision aid. Along with this improvement in SDM, patients (n = 35) demonstrated increased knowledge about their treatment choices and reported increased satisfaction in their care with no increase in decisional conflict. In contrast, clinicians (n = 6) reported that they believed they already engaged in SDM prior to use of the decision aid and, after multiple uses of the decision aid, believed patients did not understand or benefit from this tool. The disconnect between clinician and patient perspectives was sobering and has implications for the adoption of decision aids or other tools to facilitate SDM in the clinical setting. Notable limitations of the study, which are acknowledged by the authors, include (1) small sample size (of clinicians and patients); (2) the decision aid is most useful for the relatively smaller number of patients at high or prohibitive risk for surgery for whom transcatheter aortic valve replacement and medical therapy may both be reasonable options; and (3) the lack of diversity in the clinicians (all male), which reflects the current demographics of interventional cardiology and cardiac surgery.

This case report describes bilateral calcified coronary aneurysms with a significant proximal left anterior descending and right coronary artery stenoses immediately distal to the aneurysms.

This mixed-methods pilot study examines whether the repeated use of a decision aid by heart teams was associated with greater shared decision-making, along with improved patient-centered outcomes and clinicians’ attitudes about decision aids.

This study developed and validated a prognostic prediction model for patients with heart failure.

In this issue of JAMA Cardiology, Lim and colleagues report on cardiovascular functional reserve in people with end-stage renal disease before and after kidney transplant. They performed a 3-arm, prospective, concurrent cohort study to assess change in cardiovascular functional reserve after kidney transplant using state-of-the-art cardiopulmonary exercise testing (CPET). They also assessed left ventricular morphologic findings 1 year after transplant. They enrolled 81 participants with stage 5 chronic kidney disease (CKD) who underwent kidney transplant, 85 wait-listed participants with stage 5 CKD who had not undergone transplant, and 87 controls treated for hypertension only. The authors quantified cardiovascular functional reserve using CPET in parallel with transthoracic echocardiography. One year after transplant, a significant improvement in maximum oxygen consumption was found in the transplant group compared with the nontransplant group. Moreover, left ventricular function improved but not the body mass index.

To the Editor We read the recent article by Klauser et al with great interest. While the potential implications of the findings are exciting, we have several concerns. First, the authors do not explicitly state whether electrocardiogram gating was used in their study. This is an important detail because cardiac motion artifact is a source of artifactual coloration with dual-energy computed tomography (DECT), particularly with dual-source scanners given the approximately 80-millisecond temporal difference between the 2 radiography beams. Furthermore, beam hardening artifact from calcified atheromas and partial volume effect, known sources of artifacts in the 2-material decomposition algorithm of DECT, may largely explain the findings. While patients with gout had higher prevalence of coronary calcification (55 of 59 patients [93%]) and cardiovascular monosodium urate (MSU) deposition (51 of 59 patients [86%]) than controls, the authors do not report whether the 4 patients with gout without coronary calcifications exhibited MSU deposition nor the number of controls or cadaveric hearts with coronary calcification. The images from the article show areas of green pixelization occurring adjacent to calcified plaques on grayscale computed tomography images (eg, Figure 2A and D, left anterior descending artery [yellow arrowhead]), which would favor this artifact hypothesis without additional data.

In Reply We appreciate the valuable comments of Becce et al on our article. We applied prospective electrocardiography gating using a thin-slice cardiac protocol to ensure highest spatial resolution with minimal motion artifact. A noncontrast electrocardiography-gated computed tomography (CT) examination with standardized scan parameters was performed using a 128-slice dual-source CT (SOMATOM Definition Flash; Siemens) with a detector collimation of 2 × 64 × 0.6 mm, rotation time of 0.28 seconds, and prospective electrocardiography triggering for heart rates less than 65 beats per minute (diastolic padding, 70% of RR interval) and more than 65 beats per minute (systolic padding, 40% of RR interval). Axial images were reconstructed with 0.75-mm slice width, increment of 0.5, and a medium-smooth convolution kernel (B26f). When motion artifact was present, it was distinguished by visual analysis of an experienced observer and colorized pixels related to motion were excluded.

This cohort study assesses cardiovascular functional reserve before and after kidney transplant in patients with end-stage renal disease.

This cross-sectional study investigates whether hospital inpatient percutaneous coronary intervention volume is associated with rates of 30-day risk-adjusted mortality and hospital readmission after transcatheter aortic valve replacement and transcatheter mitral valve repair.

Lowering low-density lipoprotein cholesterol (LDL-C) levels remains a mainstay of cardiovascular disease prevention, but gaps in treatment remain, even in persons with hypercholesterolemia and greatly elevated LDL-C levels. Although well-described gene variants in the apolipoprotein B (APOB), low-density lipoprotein receptor (LDLR), and proprotein convertase subtilisin/kexin type 9 (PCSK9) genes explain small but important fractions of monogenic hypercholesterolemia, recent attention has turned to prognostication of cardiovascular disease using polygenic risk scores (PRS) that incorporate common genetic variants derived from large-scale genome-wide association studies of lipid subfractions. Earlier PRS considered only variants with genome-wide significance, and newer studies have focused on methods that better capture the variance conferred by millions of variants, suggesting an ability to identify risk equivalent to monogenic mutations. There remains a gap in evidence from prospective observational studies or treatment trials regarding the appropriate placement of PRS in risk assessment and lipid treatment decisions relative to information on rare monogenic gene variants, particularly in multiethnic populations.

This cohort study uses the UK Biobank cohort data to compare the association of monogenic vs polygenic hypercholesterolemia with the risk of atherosclerotic cardiovascular disease among individuals with comparable levels of low-density lipoprotein cholesterol.

In the Editorial titled “Eliminating Wasteful Health Care Spending—Is the United States Simply Spinning Its Wheels?,” published in January 2020, 2 errors appeared in the text. The surname of a cited author, Hackbarth, was mispelled as Hackbert. In addition, a mention of $282 billion was wrong; the correct value is $286 billion. The article has been corrected online.

This randomized clinical trial assesses the effectiveness of an implantable loop recorder plus 24-hour Holter electrocardiographic monitoring vs standard 24-hour Holter electrocardiographic monitoring alone for detecting arrhythmias in pregnant women with structural heart disease and/or symptoms suggestive of arrhythmias.

A 58-year-old woman presents with no relevant medical history with syncope, elevated troponin and D-dimer levels, and multiple large bilateral pulmonary emboli. What would you do next?

Secondary mitral regurgitation (MR) has long been recognized as prognostically important. Even mild MR is associated with adverse outcomes. Yet, surgical trials have not shown improved survival with invasive therapy whereas medical therapy and cardiac resynchronization therapy are associated with improved outcomes. The 2018 publication of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR) trials and their apparently discordant results have focused attention on the differences in trial design as well as patient populations.

To the Editor We read with interest the study by Sepehrvand et al, which described secular trends in the conduct of pragmatic or explanatory cardiovascular randomized clinical trials over 2 decades. We believe extension of this thoughtful analysis can provide additional insights into pragmatic vs explanatory trials.

In Reply We thank Fernandes et al for their interest in our study and agree that this field requires further exploration. Explanatory trials are primed to maximize the likelihood of finding efficacy of an intervention by testing it in an ideal setting, whereas pragmatic trials aim to test effectiveness of an intervention in a more generalizable setting. Hence, they are expected to generate more generalizable results, with the risk understood that there may be more variation in less tightly controlled environments, which may result in differing results.

This Special Communication proposes a classification of patients with left-ventricular disease according to the severity of mitral regurgitation that is proportionate vs disproportionate to left-ventricular end-diastolic volume.

This Special Communication analyzes the conclusions drawn from effective regurgitant orifice area analysis and end-diastolic volume analysis from 2 randomized clinical trials to assess disparities in the different clinical outcomes.

This essay describes a physician’s experience of the sudden, unexplained death of her brother and her family’s discovery of the genetic cause.

In the Original Investigation titled “Prognostic Models Derived in PARADIGM-HF and Validated in ATMOSPHERE and the Swedish Heart Failure Registry to Predict Mortality and Morbidity in Chronic Heart Failure,” published online January 29, 2020, there was an error in the second sentence of the Results section of the Abstract. The denominator for the number of participants should be 8399, so that the sentence reads “The mean (SD) age of participants was 64 (11.4) years, 78.2% were men (n = 6567 of 8399), and 70.6% were New York Heart Association class II (n = 8399).” This article has been corrected online.

In the Original Investigation titled “Association of Monogenic vs Polygenic Hypercholesterolemia With Risk of Atherosclerotic Cardiovascular Disease,” which published online February 12, 2020, there was an error in the Figure 3A key. The label next to the shaded box should be Mono+, and the label next to the white box should be Mono−. This article was corrected online.

In the Editorial titled “Disproportionate Emphasis on Proportionate Mitral Regurgitation—Are There Better Measures of Regurgitant Severity?,” published online February 19, 2020, there was a wording error in the fifth paragraph. The sentence beginning “Rejection fraction is calculated….” should have been “Regurgitant fraction is calculated….” This article has been corrected online.

Mission Statement: JAMA Cardiology publishes exceptional original research, state-of-the-art reviews, and informative opinions that advance the science and practice of cardiology, enhance cardiovascular health, and inform health care policy. JAMA Cardiology is the definitive journal for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. JAMA Cardiology focuses on all aspects of cardiovascular medicine, including epidemiology and prevention, diagnostic testing, interventional and pharmacologic therapeutics, translational research, health care policy and outcomes, and global health.

With the emergence of coronavirus disease 2019 (COVID-19) as a global pandemic, individuals with preexisting chronic health conditions such as hypertension, diabetes, and cardiovascular disease have been identified as particularly vulnerable. These patients are also more likely than the general population to be taking angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 gains entry into cells via binding to the angiotensin-converting enzyme 2 (ACE2) receptor, concerns have been raised that these therapies might facilitate the transmission of the virus or affect outcomes adversely. Given that ACEI and ARB therapies are known to provide benefit for the underlying conditions treated, stopping ACEI/ARB therapy carries risks. Moreover, local inactivation of the renin-angiotensin-aldosterone system may have protective effects against the development and progression of acute lung failure. In the absence of clinical evidence of benefit or risk of ACEIs/ARBs, current societal statements recommend against discontinuing these drugs other than for standard clinical indications. Robust clinical data are needed to clarify the effect of ACEIs/ARBs on SARS-CoV-2 infection.

This cohort study assesses the association between use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with the likelihood of testing positive for coronavirus disease 2019 (COVID-19).

This decision analytical model quantifies the projected gains for deaths prevented or postponed with comprehensive implementation of sodium-glucose cotransporter 2 inhibitor (SGLT2-i) therapy for patients with heart failure with reduced ejection fraction in the United States.

This genetic association study evaluates common single-nucleotide variations associated with spontaneous coronary artery dissection susceptibility.

This Viewpoint discussing implementing quality assessment metrics in percutaneous coronary intervention programs.